Single-Stage Alar Nostril Ring Correction Using Auricular Composite Grafts in Reconstructive Rhinoplasty

Overview

Over-aggressive removal of tissue at the nostril-sill junction in earlier surgery can scar the nostril into a narrow ring (external valve stenosis). The Iranian authors reviewed records from April 2016 to October 2023 of patients treated with auricular composite grafts (ACGs) in a single stage, using SCHNOS obstruction and cosmesis scores before and one year after.

Sections of note

• 45 patients (38 women, 7 men), mean age 36.4, averaging 2 previous rhinoplasties.
• Grafts came from the antihelix and were shaped like parabolic cylinders, 15-21 mm arc length, 6-9 by 3-7 mm flat.
• No graft failures, including in 10 patients with previous nasal skin necrosis.
• SCHNOS-O fell from 88.44 to 35.44; SCHNOS-C from 88.30 to 35.85 (both P < 0.05).
• Follow-up 1 year.

What it means for a patient

• A nostril scarred shut by previous surgery can be reopened with living ear tissue in one operation.
• Composite grafts are known to be risky because they depend on new blood supply, yet none failed here, even in scarred skin.
• Scores remained above zero after surgery, meaning improvement rather than complete resolution.

Why this paper matters

It is a focused series on a disabling and stigmatising revision problem with a validated outcome measure. Limits: retrospective, 45 patients, single centre, no comparison technique.

Terms

• Composite graft: a graft containing more than one tissue, here ear skin plus cartilage.
• Antihelix: the curved ridge of cartilage inside the ear rim.
• External valve stenosis: narrowing of the nostril opening.
• Alar-sill junction: where the nostril wall meets the nostril floor.
• SCHNOS: a validated nasal questionnaire with obstruction (O) and cosmesis (C) scales; lower is better.